Ureteric Clipping for the Treatment of Urinary Incontinence in Girls With Ectopic Ureters: Predicting Who Is Going to Dilate and Does It Matter?

Abstract

ObjectivesTo assess the effectiveness and midterm follow up of laparoscopic upper pole ectopic ureteral clipping to treat urinary incontinence in girls with duplex kidneys and non/poorly functioning upper pole moieties. To see if pre-operative characteristics increased the likelihood of significant post-operative dilatation and whether this dilation has clinical significance. MethodsA database review identified children who had undergone ureteric clipping at our institution. Patient details assessed included: age at presentation, age at procedure, significant past medical history, pre-operative investigations, operative time, length of stay, post-operative symptoms, post-operative renal tract ultrasound findings and the need for subsequent intervention. ResultsSix girls underwent clipping between March 2018 - May 2021. The mean age at presentation and surgery were 77months (39-186) and 86months (44-193) respectively. The mean operative time was 94 minutes (range 66-128 minutes). The median length of stay was 1 day (range 0-3 days). All the girls were dry immediately after the procedure. During a mean follow up of 51 months (29-66) all children have remained symptom free and required no further intervention. Two children have developed significant (>30mm) but stable ureteric dilatation after clipping but have remained asymptomatic and therefore are continuing on conservative follow up. Both these children had dilated ureters (>10mm) pre operatively. Conclusion:Ureteric clipping is quick, safe and effective option in dealing with incontinence due to ectopic upper pole ureters in girls. Children with pre-operative ureteric dilation seem to be at increased risk of post-operative dilation. However, as they remain asymptomatic, the clinical significance of this dilatation is unclear.